The "fit"

[patapon]

Physiatry seems so great to me on paper, yet, in person, I didn't really like my experience. My attending seemed to regret that she ever went into physiatry. She wouldn't say it, but she had a bitter edge to her that I couldn't understand (but I figure it may be due to dissatisfaction with the field). Also, my fourth-year resident seemed depressed and disappointed. He was going into a fellowship and wasn't happy about the job situation for physiatrists. The elephant in the room was: Why the heck are you considering physiatry if you could be doing something better? It was as if they couldn't believe I was showing up to work each day.

Here's my theory: Physiatrists in charge of inpatient units generally dislike their jobs. Physiatrists in the outpatient world generally like their jobs.

Comments?

Would any of you go into another lifestyle specialty if you were given the chance?

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[SportsMed09]

Where exactly are you rotating through? There's no doubt some people go into it because they could match, but I don't think you can assume EVERY inpatient attending hates their job.

 

[ShrikeMD]

Where exactly are you rotating through? There's no doubt some people go into it because they could match, but I don't think you can assume EVERY inpatient attending hates their job.

Few impressions are more profound to a medical student considering a particular specialty as a career choice than that conveyed by a disillusioned/weak attending physician.

I practice Brain Injury Medicine, and am primarily inpatient-based, though I see a lot of outpatients, including some non-BI spasticity patients. I find my inpatient brain injury practice to be very interesting, affording me an opportunity to help clinically challenging patients and their families. There are ample opportunities for clinical research in this broad field, and I have tried to integrate clinical research into my practice. I have published a sizable number of manuscripts and abstracts, and have been invited to give presentations in some cool places around the world. In short, inpatient neurorehab/BI medicine "has been very very good to me." I like it. It is a good fit for me. I also see a lot of patients with stroke, also SCI and CP, although I still find TBI to be the most professionally "enjoyable" patient population (overall).

Admittedly, when I cover for colleagues with "general" inpatient rehab services (e.g. geriatric ortho, general debility, etc.) I barely find it tolerable, and would not be happy if I spent a large portion of my professional time caring for these patient populations. (It is a good thing for those patients that my partners are around and happy to take care of them.)

There are aspects of brain injury medicine that I also don't like (the paperwork, disability forms, insurance forms, insurance hassles, maladaptive families). Most fields of medicine have aspects that are less desirable. Different strokes for different folks. I prefer to look at the bright side: Physiatry has a decided ADVANTAGE in the breadth of the potential patient populations and settings where we serve patients.

I am sorry you were exposed to colleagues who appear unhappy with their career choice. There ARE those of us with (primarily) inpatient-based neurorehabilitation practices who are very pleased with our career choices.

 

[SSdoc33]

Physiatry seems so great to me on paper, yet, in person, I didn't really like my experience. My attending seemed to regret that she ever went into physiatry. She wouldn't say it, but she had a bitter edge to her that I couldn't understand (but I figure it may be due to dissatisfaction with the field). Also, my fourth-year resident seemed depressed and disappointed. He was going into a fellowship and wasn't happy about the job situation for physiatrists. The elephant in the room was: Why the heck are you considering physiatry if you could be doing something better? It was as if they couldn't believe I was showing up to work each day.

Here's my theory: Physiatrists in charge of inpatient units generally dislike their jobs. Physiatrists in the outpatient world generally like their jobs.

Comments?

Would any of you go into another lifestyle specialty if you were given the chance?

your insight is pretty impressive for someone at your stage.

of course you cant generalize the way that you did with your "theory", but, to be honest, im not sure how off-base your little theory is.

the field is generally moving towards an outpt, spine/pain/MSK model. you will find that, in general, your more impressive and competetive residents will head in that direction, often to a fellowship. the ones who do inpatient work are GENERALLY not the go-getters and do the work that no one else really wants to do. (i hope i dont get "shriked" down with that one ).

there is no such thing as "something better". is neurosurgery or cardiology "better"? @@#%#$%# no, if you dont like neurosurg or cardiology.

if at all possible, try to spend some time with some physiatrists in the field who are energetic, impressive, and love what they do. they are out there.

however, do not be discouraged by the (?vast?) majority of your colleagues and counterparts who are sub-par. unfortunately, that is the truth. also, do not be discouraged by having to explain to your family, friends, and other docs what you do. that is a way of like in PM&R and if you can swallow your pride, its not that big a deal.

i would not consider another specialty. i had mediocre training, idiotic attendings, and some fellow residents who were passable at best. however, the fact is that there is good, cool work to be done in physiatry
if you want to do it.

best of luck

 

[Ludicolo]

Would any of you go into another lifestyle specialty if you were given the chance?

Let’s get this straight. It is not just about the lifestyle. I would shoot myself if I were practicing something like dermatology or ophthalmology (no offense to skin and eyeball doctors out there). You have to at least be quasi-interested in your chosen field, or you will find yourself stuck on a treadmill of discontent. Personally, I fit this specialty, and this specialty fits me. What I do is cool, practical, intellectually challenging, heartwrenching at times, inspiring at others.

SSdoc33 speaks the truth. The brightest are trending toward the outpatient subspecialties, and away from academia. Maybe the inpatient subspecialists (SCI, TBI) are more passionate than the inpatient generalists? He's right in that there are a lot of - shall we say - less than stellar physiatrists out there. But he's also right in that there are attendings who are talented and motivated and "get it". Your job is to find them, and learn from them.

 

[OMMFellow06]

When I was a 4th year medical student I had a couple of attendings try to discourage me from going into the field. If I had listened to them, I would probably be miserable in some other field. Luckily, I knew enough about the field and that I wanted to go into that I didn't listen to them.

You'll encounter physicians in probably every field that will tell you that they don't like their field for whatever reason. The most important thing for you as a medical student to do is find out WHY they don't like the field and figure out if that is something that is important to you. My attendings back then were saying how they weren't being compensated as well as they used to. Well I knew that wasn't something that was important enough to stop me from going into the field and boy am I glad I knew that.

So far as a resident there are definitely aspects of the field that I LOVE and some that I dont like as much. As ShrikeMD said, "general inpatient" physiatry isn't something that I enough too much. But SCI and TBI is where I think things are much more interesting and much more rewarding for me.

I agree, outpatient/MSK is also very interesting, but I think that is b/c Physiatry in general is very interesting. There are so many different aspects of it that I think most everyone who goes into it will find something that they really enjoy.

So to patapon and other medical students, don't let one or two attendings discourage you if you know that this field, or another other field for that matter, is the field that you want to go into. Unless of course they tell you negatives that would be important to you.

Just think of the grain of salt...take everything that people tell you as a grain of salt and put it all together and formulate your own opinion.

 

[PMR 4 MSK]

Bummer to have a bad experience .

Most PM&Rs I have met are bright, upbeat and positive people, because that's the way our field is focused - not on what's wrong, but what we can do about it. We are a creative lot, because of such diversity of patient presentation, it's rare to find a patient who "fits the mold" of any given Dx.

If you have time, try another rotation in another facility to compare. Even if it's only for a day or two.

There have been times when I have questioned whether this truely was the best field for me. I've also questioned if I went to the best residency, med school and college for me. I can't imagine another field I would enjoy more.

Physician (attending) job satisfaction appears to be on the decline in all fields. Everyone seems to feel they are overworked, underpaid and dealing with ungrateful, demanding patients. That's medicine, and no one outside of medicine will ever feel sorry for you. You'll make more $ than 90% of Americans no matter what you go in to, you'll have more vacation time, and a better lifestyle than most of your non-medical friends and family.

Finding your "fit" is not easy. I was lucky enough to take one PM&R rotation and by the 3rd day say "Yep, this is what I want to do for the rest of my life." I confirmed that taking neuro, ortho, rheum, etc.

If you let us know where you are, we might be able to refer you to someone who would likely give you a more positive outlook on the field.

 

[Hemisphere]

woah lets be careful making generalizations here... the "brightest" go into outpatient, etc, and shy away from academia? only so they can quickly 'turn off' their minds and never do any research or teaching, and start raking in the dough, well I guess that takes a certain kind of smarts.

personally, i wouldn't go into any other field if given the chance. this field is awesome. quality of life baby. enhance the quality. neurology without the midnight stroke alerts, orthopedics without the 5 AM rounds. yeah inpatient rotations can be tough but that is where the physiatrist will have the opporutnity to see the most rapid and lasting improvements in quality of life and function, the opportunity to be the greatest leader. the sharpest sword is made in the hottest fire. most people, understandably, don't like to hang out in a burning building... it can get stressful. overnight calls and weekends, it's enough to make anyone disgruntled if they are doint too much of it.

obviously, you will need to get a second opinion from another doctor, make sure it's not just one person's problems vs. something you don't like about the field. there are MANY niches in physiatry. explore as many as you can, decide where you might like to fit in. If this is for you, you are an enabler at heart, you want to see others succeed, and when they do you can take credit for the role you played and be happy. yeah there will be people who dream of other fields and disgruntled, but you won't be one of them.

 

[Fro]

only so they can quickly 'turn off' their minds and never do any research or teaching, and start raking in the dough, well I guess that takes a certain kind of smarts.

talk about generalizations...

 

[LTS6776]

It's really not fair to say that the brightest people go into outpatient musculoskeletal care. As with any field, people enter our specialty with a lot of different interests and motivations. Inpatient work can be very rewarding, but as with any specialty, there are going to be times when it is less so. It can be very frustrating for residents to deal with the deluge of Friday admissions as other specialties try to diurese their hospital services. It can also be a pain to constantly have to explain what it is you do. But, if you like to work with people during a challenging time of their life to get them back to as a normal life as possible, it might be a good fit for you. In reality, many "general" rehab physicians have a niche or two that they try to build on top of staying "general" enough to be able to care for disabled patients who might not have anyone else able to care for their rehab needs. If you had a bad experience and are still interested in the specialty, I would encourage you to try to do another rotation or spend some time with another rehab department. Unfortunately, although there are a lot of great programs out there, there are also some duds (and sometimes at places you wouldn't expect them to be). And, there are people who enter the specialty for the wrong reasons - like being a relatively easy Match. If you choose to do a PM&R residency, go some place where you are going to get good exposure to all aspects of our field and then make a decision as to what you would be most happy doing.

 

[AviatorDoc]

It didn't take me very long to realize the PM&R "fit". I was nonchalant about most of my rotations in med school... as my 3rd year wound down I realized that I needed to pick a specialty, and didn't know what I wanted. Doing a month with PM&R attendings who were passionate about what they did absolutely nailed it on the head for me.

Now as for the elephant in the room -- was money a factor? To say absolutely not would be a lie. There are lots of fun procedures in PM&R, and procedures pay well. However, I'd like to think that if I never knew PM&R existed and instead went into FP or Peds (my 2nd and 3rd choices respectively), that I would have figured a way to make money anyway. Remember that income and wealth are only indirectly related (reference MC Hammer, Evander Holyfield, and most multi-million dollar lottery winners).

BTW... Can you make a whole bunch of money doing inpatient/neurorehab? You bet. I know of someone who bills close to 7 figures a year, without spinal procedures or electrodiagnosis.

Finally, do what you love or at least what you can learn to love.

 

[Sartre79]

Is PM&R really paid that well compared to other specialties?

It didn't take me very long to realize the PM&R "fit". I was nonchalant about most of my rotations in med school... as my 3rd year wound down I realized that I needed to pick a specialty, and didn't know what I wanted. Doing a month with PM&R attendings who were passionate about what they did absolutely nailed it on the head for me.

Now as for the elephant in the room -- was money a factor? To say absolutely not would be a lie. There are lots of fun procedures in PM&R, and procedures pay well. However, I'd like to think that if I never knew PM&R existed and instead went into FP or Peds (my 2nd and 3rd choices respectively), that I would have figured a way to make money anyway. Remember that income and wealth are only indirectly related (reference MC Hammer, Evander Holyfield, and most multi-million dollar lottery winners).

BTW... Can you make a whole bunch of money doing inpatient/neurorehab? You bet. I know of someone who bills close to 7 figures a year, without spinal procedures or electrodiagnosis.

Finally, do what you love or at least what you can learn to love.

 

[ShrikeMD]

Is PM&R really paid that well compared to other specialties?

Most inpt neurorehab docs aren't collecting near-seven figures/year; I can't speak for billing. Some LTAC-rehab hospitals that don't take medicaid or medicare (and have few charity pts), have faculty members that generate some pretty high incomes. However, I don't believe those are representative of most inpt-neurorehab docs.

 

[AviatorDoc]

I didn't want to come across as saying all inpt rehab docs make that much. Obviously that's an outlier.

From what I understand, an inpt rehab doc should look to bring home in the neighborhood of 175-300 K average.

Again, you should choose a specialty because you enjoy doing it. PM&R is just fun. I don't drag myself out of bed to go to work. The days go by so fast, I have to remind myself that yes, they are actually paying me to do this. I actually enjoy opening up a book and reading.

If you had a bad experience as a student, go somewhere else and try again. Places I can personally recommend as being "fun": U of Utah, San Antonio, Kentucky, Missou, Cincinnatti.

 

[ShrikeMD]

I didn't want to come across as saying all inpt rehab docs make that much. Obviously that's an outlier.

From what I understand, an inpt rehab doc should look to bring home in the neighborhood of 175-300 K average.

Again, you should choose a specialty because you enjoy doing it. PM&R is just fun. I don't drag myself out of bed to go to work. The days go by so fast, I have to remind myself that yes, they are actually paying me to do this. I actually enjoy opening up a book and reading.

If you had a bad experience as a student, go somewhere else and try again. Places I can personally recommend as being "fun": U of Utah, San Antonio, Kentucky, Missou, Cincinnatti.

Those $$$ figures are about right. Agree with your reasons for choosing the specialty/subspecialty/place to work. Fun/interesting/meaningful/etc.

 

[SSdoc33]

I didn't want to come across as saying all inpt rehab docs make that much. Obviously that's an outlier.

From what I understand, an inpt rehab doc should look to bring home in the neighborhood of 175-300 K average.

Again, you should choose a specialty because you enjoy doing it. PM&R is just fun. I don't drag myself out of bed to go to work. The days go by so fast, I have to remind myself that yes, they are actually paying me to do this. I actually enjoy opening up a book and reading.

If you had a bad experience as a student, go somewhere else and try again. Places I can personally recommend as being "fun": U of Utah, San Antonio, Kentucky, Missou, Cincinnatti.

not including PM&R residency, places i can personally recommend as NOT being "fun": U of Utah, San Antonio, Kentucky, Missou, Cincinnatti --GOO!!!!!!!!!!